Skip to main content
SpringerLink
Log in

Edwards Sapien XT valve placement as treatment option for aortic regurgitation after transfemoral CoreValve implantation: a multicenter experience

  • Original Paper
  • Published:
Clinical Research in Cardiology Aims and scope Submit manuscript

Abstract

Transcatheter aortic valve replacement (TAVI), though a preferred treatment option in the elderly population carrying increased risks for open heart surgery, may result in prognosis-limiting moderate or severe aortic regurgitation. Here, we report a series of 11 patients from 3 German TAVI centers, suffering from moderate- to high-grade aortic regurgitation after CoreValve implantation, who were subsequently treated by Edwards Sapien XT implantation.

Methods

The patients were 79.5 ± 4.2 years of age and presented between November 2009 and February 2013 with a symptomatic high-grade aortic stenosis (mean maximum gradient 57 ± 22 mmHg) and EuroSCORE of 16 ± 7 %. Initial implantation of a Medtronic CoreValve resulted in moderate-to-severe aortic regurgitation (grade 2.64 ± 0.37) although postdilatation was attempted in eight cases and snare repositioning was attempted in one case.

Results

All 11 patients were treated by a Sapien XT (Edwards) valve implanted into the initially deployed CoreValve: four via transfemoral, one via transaortical and six via transapical approaches. Successful implantation was possible in all 11 patients resulting in a reduction of aortic regurgitation to mean grade 0.23 ± 0.39. Two patients required permanent pacemaker. After 30 days, ten patients were alive, whereas one patient succumbed to pneumonia complicating advanced chronic obstructive pulmonary disease.

Conclusion

In the instance of moderate or severe aortic regurgitation after TAVI of a CoreValve, transfemoral or transapical Sapien XT valve-in-valve deployment is an excellent option to reduce residual regurgitation to none or mild.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4

Similar content being viewed by others

References

  1. Smith CR et al (2011) Transcatheter versus surgical aortic-valve replacement in high-risk patients. N Engl J Med 364(23):2187–2198

    Article  CAS  PubMed  Google Scholar 

  2. Makkar RR et al (2012) Transcatheter aortic-valve replacement for inoperable severe aortic stenosis. N Engl J Med 366(18):1696–1704

    Article  CAS  PubMed  Google Scholar 

  3. Kodali SK et al (2012) Two-year outcomes after transcatheter or surgical aortic-valve replacement. N Engl J Med 366(18):1686–1695

    Article  CAS  PubMed  Google Scholar 

  4. Ussia GP et al (2012) Transcatheter aortic valve implantation: 3-year outcomes of self-expanding CoreValve prosthesis. Eur Heart J 33(8):969–976

    Article  PubMed  Google Scholar 

  5. Tamburino C et al (2011) Incidence and predictors of early and late mortality after transcatheter aortic valve implantation in 663 patients with severe aortic stenosis. Circulation 123(3):299–308

    Article  PubMed  Google Scholar 

  6. Zahn R et al (2011) Correction of aortic regurgitation after transcatheter aortic valve implantation of the Medtronic CoreValveTM prosthesis due to a too-low implantation, using transcatheter repositioning. J Heart Valve Dis 20(1):64–69

    PubMed  Google Scholar 

  7. Leon MB et al (2011) Standardized endpoint definitions for transcatheter aortic valve implantation clinical trials: a consensus report from the valve academic research consortium. J Am Coll Cardiol 57(3):253–269

    Article  PubMed  Google Scholar 

  8. Vasa-Nicotera M et al (2012) Impact of paravalvular leakage on outcome in patients after transcatheter aortic valve implantation. JACC Cardiovasc Interv 5(8):858–865

    Article  PubMed  Google Scholar 

  9. Gripari P et al (2012) Intraoperative 2D and 3D transoesophageal echocardiographic predictors of aortic regurgitation after transcatheter aortic valve implantation. Heart 98(16):1229–1236

    Article  PubMed  Google Scholar 

  10. Buzzatti N et al (2012) Computed tomography-based evaluation of aortic annulus, prosthesis size and impact on early residual aortic regurgitation after transcatheter aortic valve implantation. Eur J Cardiothorac Surg 43:43–50

    Article  PubMed  Google Scholar 

  11. Willson AB et al (2012) 3-dimensional aortic annular assessment by multidetector computed tomography predicts moderate or severe paravalvular regurgitation after transcatheter aortic valve replacement: a multicenter retrospective analysis. J Am Coll Cardiol 59(14):1287–1294

    Article  PubMed  Google Scholar 

  12. Takagi K et al (2011) Predictors of moderate-to-severe paravalvular aortic regurgitation immediately after CoreValve implantation and the impact of postdilatation. Catheter Cardiovasc Interv 78(3):432–443

    PubMed  Google Scholar 

  13. Patsalis PC et al (2012) Incidence, outcome and correlates of residual paravalvular aortic regurgitation after transcatheter aortic valve implantation and importance of haemodynamic assessment. EuroIntervention 8:1398–1406

    Article  Google Scholar 

  14. Moat NE et al (2011) Long-term outcomes after transcatheter aortic valve implantation in high-risk patients with severe aortic stenosis: the UK TAVI (United Kingdom transcatheter aortic valve implantation) Registry. J Am Coll Cardiol 58(20):2130–2138

    Article  PubMed  Google Scholar 

  15. Abdel-Wahab M et al (2011) Aortic regurgitation after transcatheter aortic valve implantation: incidence and early outcome. Results from the German transcatheter aortic valve interventions registry. Heart 97(11):899–906

    Article  PubMed  Google Scholar 

  16. Unbehaun A et al (2012) Transapical aortic valve implantation: incidence and predictors of paravalvular leakage and transvalvular regurgitation in a series of 358 patients. J Am Coll Cardiol 59(3):211–221

    Article  PubMed  Google Scholar 

  17. Seiffert M et al (2012) Predictors and outcomes after transcatheter aortic valve implantation using different approaches according to the valve academic research consortium definitions. Catheter Cardiovasc Interv 82:640–652

    Google Scholar 

  18. Detaint D et al (2009) Determinants of significant paravalvular regurgitation after transcatheter aortic valve: implantation impact of device and annulus discongruence. JACC Cardiovasc Interv 2(9):821–827

    Article  PubMed  Google Scholar 

  19. Zahn R et al (2011) Transcatheter aortic valve implantation: first results from a multi-centre real-world registry. Eur Heart J 32(2):198–204

    Article  PubMed  Google Scholar 

  20. Hutter A et al (2010) Aortic annulus evaluation in transcatheter aortic valve implantation. Catheter Cardiovasc Interv 76(7):1009–1019

    Article  PubMed  Google Scholar 

  21. Napodano M et al (2011) Performance of valve-in-valve for severe para-prosthetic leaks due to inadequate transcatheter aortic valve implantation. Catheter Cardiovasc Interv 78(7):996–1003

    Article  PubMed  Google Scholar 

  22. Eggebrecht H et al (2012) Interventional options for severe aortic regurgitation after transcatheter aortic valve implantation: balloons, snares, valve-in-valve. Clin Res Cardiol 101(6):503–507

    Article  PubMed  Google Scholar 

  23. Leber AW et al (2011) Aortic valve calcium score as a predictor for outcome after TAVI using the CoreValve revalving system. Int J Cardiol 166:652–657

    Article  PubMed  Google Scholar 

  24. Greif M et al (2012) Transcatheter Edwards Sapien XT valve in valve implantation in degenerated aortic bioprostheses via transfemoral access. Clin Res Cardiol 101(12):993–1001

    Article  PubMed  Google Scholar 

Download references

Conflict of interest

All authors declare that they have no potential conflict of interest.

Author information

Authors and Affiliations

  1. Klinik für Allgemeine und Interventionelle Kardiologie, Universitäres Herzzentrum Hamburg, Hamburg, Germany

    Patrick Diemert, Moritz Seiffert & Stefan Blankenberg

  2. Medizinische Klinik Und Poliklinik I, Klinikum der Universität München, Campus Großhadern, Marchioninistraße 15, 81377, Munich, Germany

    Philipp Lange, Martin Greif, Steffen Massberg & Christian Kupatt

  3. Klinik und Poliklinik für Herz- und Gefäßchirurgie, Universitäres Herzzentrum Hamburg, Hamburg, Germany

    Lenard Conradi, Hermann Reichenspurner & Hendrik Treede

  4. Medizinische Klinik IV, Klinikum Karlsruhe, Karlsruhe, Germany

    Gerhard Schymik

  5. Herzchirurgische Klinik, Klinikum der Universität München, Campus Großhadern, Munich, Germany

    Christian Hagl & Christoph Schmitz

  6. Klinik für Herzchirurgie, Karlsruhe, Germany

    Holger Schröfel

Authors
  1. Patrick Diemert
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Philipp Lange
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Martin Greif
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Moritz Seiffert
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Lenard Conradi
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Steffen Massberg
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Stefan Blankenberg
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Hermann Reichenspurner
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. Christian Hagl
    View author publications

    You can also search for this author in PubMed Google Scholar

  10. Christoph Schmitz
    View author publications

    You can also search for this author in PubMed Google Scholar

  11. Holger Schröfel
    View author publications

    You can also search for this author in PubMed Google Scholar

  12. Hendrik Treede
    View author publications

    You can also search for this author in PubMed Google Scholar

  13. Gerhard Schymik
    View author publications

    You can also search for this author in PubMed Google Scholar

  14. Christian Kupatt
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Philipp Lange.

Additional information

P. Diemert, P. Lange, and M. Greif contributed equally to this work.

G. Schymik and C. Kupatt share last authorship.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Diemert, P., Lange, P., Greif, M. et al. Edwards Sapien XT valve placement as treatment option for aortic regurgitation after transfemoral CoreValve implantation: a multicenter experience. Clin Res Cardiol 103, 183–190 (2014). https://doi.org/10.1007/s00392-013-0632-8

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00392-013-0632-8

Keywords

Search

Navigation